When patients with mental illnesses such as schizophrenia, severe bipolar disorder and major depression need treatment but refuse it, Sedgwick County sends them involuntarily to Osawatomie State Hospital.
Osawatomie is one of two psychiatric hospitals operated by the state. It has been consistently over its capacity for the past year, leading the director of Comcare, which provides mental health services for Sedgwick County, to express concern about whether patients are receiving adequate treatment. She also worries that overcrowding is leading to patients being discharged before they should be.
Marilyn Cook, the director, says Kansas needs to expand its state hospitals. Even better, she said, would be regional treatment centers so patients could get help closer to their homes, families and support systems.
"A couple of weeks ago, they had their highest over census. They were 26 over census," Cook said Friday of Osawatomie, which is about three hours from Wichita.
Such crowding, she said, can have disastrous results for people needing treatment for severe mental illness.
As of Thursday, Osawatomie was over capacity in September on 19 days. In July, it was over capacity 24 days.
The county is asking the state to think more about whether state hospitals are the best places to treat people. It's pushing for local inpatient centers paid for by the state.
The Kansas Department of Social and Rehabilitation Services said there is no plan to move toward a regional system.
The state operates two psychiatric hospitals — Osawatomie and Larned State Hospital. It also operates Rainbow Mental Health Facility, which also serves psychiatric patients but fewer of them.
SRS public information officer Rachel Whitten said Friday that neither Osawatomie nor Larned were overcrowded at the time. Records show that Osawatomie's average daily census for fiscal year 2011 was 173. The hospital has 176 beds.
Whenever Osawatomie gets close to capacity, "the community mental health centers, which screen the patients and basically control admissions for Osawatomie, will divert new patients to a contracted hospital for mental health treatment. In Wichita, that's Via Christi. The patients that need treatment get treatment," Whitten said.
Cook said Wichita is lucky to have Via Christi Behavioral Health Center.
Cook worries about patients in communities that don't have such centers.
"There are a number of small community hospitals that can handle that population but they really have to be paid for that. It always boils down to dollars," Cook said.
On Thursday, there were 167 patients at Osawatomie and 30 patients at Rainbow, Whitten said.
Still, Cook said that "more and more of the time," the hospital is either at capacity or over it.
"There are many problems when the state hospitals are this crowded for this long," she said. "There's a tendency for people to return (home) when they're not stable enough to do that. It's very precarious for everyone when they are discharged or released back into the community when they're not ready to do that."
Sometimes, they have to be readmitted, which is costly, Cook said. Patients must be screened — in Sedgwick County, that's done at Comcare — before being admitted to a state hospital.
"We end up rescreening them," she said. "Transportation is very expensive to and from the state hospital."
The sheriff's office transports involuntary patients, she said.
Last year, 799 people were admitted to a state hospital from the Wichita area, Cook said. Comcare sends only involuntary patients to a state hospital. Voluntary patients go to Via Christi. From January through August this year, the number of patients sent to state hospitals from the county totaled 617.
It cost the county more than $200,000 to transport patients to the state hospital last year, Cook said.
Cook didn't have staff costs available Friday, but she said Comcare staff make two trips to Osawatomie every week to meet with patients.
She said regional, state-operated mental health units "would be preferable, less costly and less disruptive to these individuals and their families."
It is far "easier for people to stabilize close to home," she said. "Family is able to participate in the treatment process. They just tend to do better if that hospitalization is close to them."
SRS has not budgeted for more beds for fiscal year 2012, Whitten said.
She said SRS "welcomes ideas and suggestions from legislators. That said, Kansans who need inpatient mental health treatment right now are being served — either by Osawatomie or our other state hospitals, or by hospital contracts. They are getting the care and treatment they need regardless of the location."